Abstract
Although colorectal cancer is one of the most common malignancies worldwide, the colon cancer related mortality significantly decreased in the last decades due to the wide implementation of screening programs and due to a better therapeutic approach. Once Heald introduced the concept of total mesorectal excision and demonstrated its’ benefits in terms of oncologicaloutcomes, attention was focused on the possibility of implementation of a similar technique for patients with colon cancer. This is how the concept of complete mesocolic excision appeared. This is a literature review regarding the surgical technique and oncologic outcomes of complete mesocolic excision.
Highlights
Colorectal cancer is a major health problem, being the third most frequent cancer in men (764,000 cases/year) and the second in women (614,000 cases/year) [1]
After 70 years, a new revolution in radical surgery was performed by Heald et al [4], who introduced the concept of total mesorectal excision (TME), the primitive embryological dorsal mesentery of the rectum, reaching significant local control, 5-year overall survival and disease-free survival [5]
The concept of complete mesocolic excision (CME) with central vascular ligation (CVL) consists of creating an intact specimen encompassing the primary neoplasia along with all the potential pathways of tumor spread through central ligation of the main artery at its origin [9,10]
Summary
In 2009, translating the concept of TME, came the first report and description of the complete mesocolic excision (CME) with central vascular ligation (CVL) from the Erlanger group of Hohenberger with impressive oncological outcomes and an overall 5 year survival reaching up to 70% for stage III colon cancer patients. They demonstrated that this is a safe and feasible technique with at least the same morbidity and mortality as the “so called” standard technique. Resection must be complete to be considered curative, and positive lymph nodes left behind indicate an incomplete (R2) resection [24,25]
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